|Year : 2019 | Volume
| Issue : 1 | Page : 30-36
Patient awareness and perceived cost of dental implants for replacement of missing teeth: A survey in an Indian metropolitan population
Ninad Milind Padhye1, Prasad Diwakar Bhange2, Lopa Kishor Mehta2, Sonika M Khimani2
1 Department of Periodontics, Ceramco Dental Care, Mumbai, Maharashtra, India
2 Department of Dental Surgery, King Edward Memorial Hospital, Mumbai, Maharashtra, India
|Date of Web Publication||17-Jun-2019|
Dr. Ninad Milind Padhye
Ceramco Dental Care, Lokhandwala Complex, Andheri West, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: Implant dentistry has gained immense popularity in the field of oral rehabilitation. However, a lack of patient awareness about the procedure, its advantages, and limitations results in a lack of their active participation in the treatment plan. The aim of this study was, with the help of a questionnaire, to assess up-to-date patients' perspectives on dental implants and its cost.
Materials and Methods: A questionnaire-based survey of 14 questions was distributed among 1000 randomly selected participants attending ten private clinics in the city of Mumbai, India. Frequencies and percentages of the responses were tabulated and calculated.
Results: Among the participants of the survey, 90.5% were of the opinion that missing teeth should be replaced, but only 53.6% were aware about dental implants. About 65.7% of these individuals received information about dental implants from dentists and 42.3% considered the implant to last for a lifetime. About 39.4% of the participants thought that the biggest advantage of the implant was a fixed replacement to a missing tooth, whereas the high cost associated with the procedure was the biggest disadvantage as considered by 43.7% of participants. A majority of them (75.9%) expressed that treatment was nonaffordable; however, they were willing to learn more about the treatment modality.
Conclusion: The survey concluded that 53.6% of the Indian metropolitan population had heard about dental implants as a treatment option but considered it expensive. Improved doctor–patient communication would be needed to avoid misconceptions regarding the implant therapy and the cost associated with it.
Keywords: Cost of implant, dental implant, India, survey, treatment awareness
|How to cite this article:|
Padhye NM, Bhange PD, Mehta LK, Khimani SM. Patient awareness and perceived cost of dental implants for replacement of missing teeth: A survey in an Indian metropolitan population. J Dent Implant 2019;9:30-6
|How to cite this URL:|
Padhye NM, Bhange PD, Mehta LK, Khimani SM. Patient awareness and perceived cost of dental implants for replacement of missing teeth: A survey in an Indian metropolitan population. J Dent Implant [serial online] 2019 [cited 2019 Oct 13];9:30-6. Available from: http://www.jdionline.org/text.asp?2019/9/1/30/260450
| Introduction|| |
Dental implants, introduced almost 35 years ago, have revolutionized the field of oral rehabilitation. Partial and completely edentulous patients can now opt for dental implants to provide them with fixed replacements to their missing teeth. The major clinical advantage of a dental implant over a fixed partial denture is that they do not require tissue destruction of healthy adjacent teeth.
Decision-making in implant dentistry involves patients' preferences and values, clinician knowledge and skills, diagnostic and therapeutic apprehensions, as well as cost considerations. Currently, dental implants are widely accepted as a prosthetic treatment of completely and partially edentulous patients., Since implant therapy is an elective surgical procedure, an active participation by the patient with a keen motivation is essential for its long-term success. For this, a thorough patient knowledge wherein the patients know about the advantages and limitations of implants as a tooth replacement option is necessary. However, little information is available to the general population regarding the dental implant procedure. More often than not, the public is confronted with confusing and deceiving information provided by the media, which is usually marketing oriented. It is commonly noted that treatment options are dictated by the operating dentist with the patient taking a back seat in the decision-making process. With a worldwide estimate of almost 1 million implants being placed annually, providing implant-related knowledge to the general public is the need of the hour.
Most implant-related publications talk about quality assurance based on extensive research. However, information for the patients themselves should not be neglected as they play a major role in the decisions made. Recent figures show that 98% of the implant-related publications are clinician oriented whereas studies dealing with patient opinions regarding the treatment and its perceived cost are extremely limited. This problem is exponentially magnified in developing nations due to a lack of education and awareness among the masses about dental implant as a treatment modality. For the professional community, it is vital to provide adequate means of information to the general public, thus helping to ward off a negative image about implant dentistry which may be caused by a communication gap.
Successful oral rehabilitation requires both functional and psychosocial adaptation by the patients. Among all the parameters affecting the outcome of restorative dentistry, including the biologic, physiologic, and psychosocial parameters, the economic parameters such as the cost of fabrication and maintenance, patient preferences such as treatment time, are the most neglected. For the clinician, implant survival, prosthesis longevity, and the frequency of complications are the most important parameters. However, the social and psychological impact of the treatment along with its cost-effectiveness is more significant from a patient's point of view. Economic parameter would play a major role in the decision taken by the patient in implant dentistry.
With the recent immense popularity of dental implants as a fixed prosthetic replacement option, it is necessary to find the expectations and perceived cost by the general masses, for the implant procedure. A survey regarding the same would in-turn help the dental community to provide a realistic outlook toward the implant procedure as a whole. Therefore, the aim of the survey was to assess up-to-date patients' perspectives on dental implant therapy and its cost.
| Materials and Methods|| |
This was a questionnaire-based cross-sectional study. The questionnaire consisted of 14 questions related to the patient awareness and knowledge about implant treatment [Table 1]. The survey was conducted at the dental surgery department clinic at King Edward Memorial Hospital, Mumbai along with 10 private dental clinics in central Mumbai. Ethical approval was obtained, and a sample size of 1000 randomly selected individuals visiting these clinics was collected. At each center, written informed consent of the patients willing to participate in the study was taken, and the questionnaire was provided, which was in the local language. The investigators checked the filled questionnaire forms for invalid entries before submission.
|Table 1: Distribution of responses of the participants to various questions|
Click here to view
Inclusion criteria were participants who were over 18 years of age and literate. Exclusion criteria included individuals who are seriously or terminally ill, mentally challenged, physically handicapped, and individuals who have previously undergone dental implant therapy. Demographic data such as age, education, profession, and monthly income were collected for the individuals to segregate them into various groups.
Based on the demographic data collected, the participants were segregated according to their age (18–25, 25–40, 40–55, 55–70, and above 70), education (studied up to primary school, studies up to high school, graduates, postgraduates), profession (self-employed, civil servants/professionals, manual laborers, students, retirees, and unemployed), and monthly income (<'10,000, '10,000–25,000, '25,000–50,000, '50,000–'1,00,000, and >'1,00,000). The GCP guidelines were followed, and the survey was in accordance to STROBE statement for cross-sectional studies.
Completed questionnaires were coded, and data were tabulated in Microsoft Excel (MS office version 2010). Data analysis was done using Windows PC-based software “MedCalc Statistical Software” version 13.3.1 (MedCalc Software bvba, Ostend, Belgium; http://www.medcalc.org; 2014). All testing were done at alpha 0.05 (95% confidence limits). Distribution of responses was examined using frequencies and percentages. Descriptive statistics was presented for the scores of questionnaires in the groups based on age, gender, education, and family income.
| Results|| |
The demographic data of the samples are presented in [Table 2]. Among the study participants, 9.5% (n = 95) were unaware about the need for replacement of missing teeth whereas only 53.6% (n = 536) knew about dental implant as an option for tooth replacement. The various sources of information for dental implants for the individuals are shown in [Figure 1]. Among the participants aware about dental implants, 55.1% (n = 295) considered 3–6 months as the time required for the complete implant-supported rehabilitation [Figure 2] and 42.3% (n = 227) expected the implants to last for a lifetime [Figure 3]. About 39.3% (n = 211) considered implants as a better option for tooth replacement as it is a fixed prosthesis whereas 29.6% (n = 159) considered it better as it prevented grinding of the adjacent teeth [Figure 4]. The high cost associated with the dental implant procedure was considered as the biggest disadvantages by most of the participants (43.7%, n = 234) [Figure 5] and 55.2% (n = 296) considered implants are expensive and the cost associated for it is too much. About 28.3% (n = 152) of the participants considered implants to cost >'30,000 [Figure 6], and the dentists (58.8%, n = 315) were considered mainly responsible for the final price of the implants followed by the laboratory technician (16.4%, n = 88), manufacturer (12.9%, n = 69), and dealer (7.3%, n = 39) [Figure 7].
|Figure 1: Percentage distribution of various sources of implant information, among participants aware about dental implants (n = 536)|
Click here to view
|Figure 2: Percentage distribution of time required for implant procedure, as considered by the participants aware about dental implants (n = 536)|
Click here to view
|Figure 3: Percentage distribution of how long an implant lasts, as considered by the participants aware about dental implants (n = 536)|
Click here to view
|Figure 4: Percentage distribution of biggest advantage of implants, as considered by the participants aware about dental implants (n = 536)|
Click here to view
|Figure 5: Percentage distribution of biggest disadvantage of implants, as considered by the participants aware about dental implants (n = 536)|
Click here to view
|Figure 6: Percentage distribution of cost of an implant, as considered by the participants aware about dental implants (n = 536)|
Click here to view
|Figure 7: Percentage distribution of deciding factor for final cost of implant, as considered by the participants aware about dental implants (n = 536)|
Click here to view
| Discussion|| |
With an ever-increasing success rate, dental implants have been at a forefront of clinical dental practice in case of oral rehabilitation. This procedure is becoming a focus of patients' interest for over a decade now. However, although current research puts a focus on reduction in treatment time and invasiveness of the procedure, little is known about the factors that motivate patients to choose dental implant therapy. Therefore, the primary outcome assessed in this survey was the patient's knowledge and awareness regarding the procedure of implant therapy and its cost.
This study was conducted among a representative urban Indian population where the educational status, profession, and monthly income were ascertained. It was found that 905 (90.5%) participants were aware about the need for replacement of a missing tooth; however, only 536 (53.6%) had heard of or were aware about dental implants as a treatment option. When questioned regarding the same, 714 (71.4%) of the participants said they would like more information about dental implants. A break-up analysis showed that high professional qualification along with a high income can be considered as main influences in the level of awareness about dental implants.
From the present study, in general, the contribution of the media toward public information was low. Only 13.2% of the participants received information about dental implants from various sources of mass media such as the internet, TV, or newspapers, which was similar to a survey conducted by Rustemeyer et al. in Germany in 2007. Dentists (65.7%) were considered the most common source for providing information about dental implants, which was similar to a survey conducted by Chowdhary et al. in an urban Indian population in 2009, but was in contrast to the survey conducted by Zimmer et al. in 1992 among the citizens of the United States, where the dentists were the source of information for only 17% of the respondents. This clearly points toward the role of the dentist and calls into question the responsibility of mass media, in India, toward public awareness.
From the patient's point of view, dental implants are advantageous since they are a fixed replacement to the lost tooth (39.4%) and also prevented grinding of the adjacent natural teeth (29.6%). This finding is in accordance with the results from the survey conducted by Satpathy et al. in 2011. However, a substantial number of individuals (42.3%) considered implants to last for a lifetime without additional care. This unrealistic expectation from a huge number of participants demonstrates the need for education and awareness regarding the same, to ward off misconceptions and bridge the information gap.
Over the past few years, the patients' complaints of high treatment cost have increased significantly, and even in our study, the high cost associated with the procedure of dental implant rehabilitation was considered as the biggest disadvantage by 43.7% of the participants. This was in agreement with the American and Japanese surveys conducted by Zimmer et al. and Akagawa et al., respectively, and points toward a need for dental insurance coverage. Social traditions, such as what patients are used to receiving without payment or for subsidized prices depending on the operating dental surgeon, also influence the value of money in dental healthcare. Hence, the cost values stated by the patients in this study is only a symbolic representation of what patients would be prepared to pay for dental implants, and not a definite undertaking to pay the specified price.
This study adds to the literature the viewpoints of the urban Indian population regarding dental implant and its perceived cost. Considering that almost three-quarters of the participants desired to get their missing tooth replaced with a dental implant, the market potential for implant rehabilitation is huge. Although 58.8% of the individuals felt that the dentist was mainly responsible for the high cost and the final pricing of the implant, more information to the patients about the investments needed for implant procedures, along with separate training and continuing dental education required, could help them accept the expenses more readily. Furthermore, it is certain that a tremendous number of patients of a lower socioeconomic status would accept dental implants if there is a government-employed patient healthcare policy associated with the same.
Although a genuine effort was made to collect the data for this study, it does have its share of limitations. Most of the participants of the survey belonged to the middle-aged group which cannot be considered a representative of the general population. A larger sample size with relatively more heterogeneity in the population would have given a better idea about the patient's viewpoints regarding dental implants. Future research on a similar front can also segregate the participants based on whether they had undergone implant therapy themselves or not. Furthermore, a review summarizing similar studies based on this topic would provide organized data, to the clinician, to educate the patients about the advantages and disadvantages of implant dentistry along with the cost of the procedure.
This survey is clinically significant as patient's viewpoints regarding implant dentistry and its perceived cost were determined. This would in-turn help the dental community provide information to the patients to create awareness about the general costing of the implant procedure and ward off the misconception among general public that implant rehabilitative procedures are only for the rich. The data obtained could be very useful to come up with guidelines for patient education and motivation strategies for dental implants in the Indian metropolitan region. A bigger role played by the media in reaching out to the masses and providing information along with the realistic benefits could exponentially increase the patient acceptance toward implant-supported rehabilitation.
| Conclusion|| |
Within the limitations of this survey, it can be inferred that although patients are aware about the need to replace a missing tooth, the level of awareness about dental implants is significantly low. Most patients found the implant procedure to be nonaffordable but were interested to know details regarding the same. Increased efforts to provide correct information, regarding dental implants, to the patients to improve awareness should be undertaken by the dentist and media in collaboration.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Abdulmajeed AA, Lim KG, Närhi TO, Cooper LF. Complete-arch implant-supported monolithic zirconia fixed dental prostheses: A systematic review. J Prosthet Dent 2016;115:672-70.
Pommer B, Becker K, Arnhart C, Fabian F, Rathe F, Stigler RG. How meta-analytic evidence impacts clinical decision making in oral implantology: A Delphi opinion poll. Clin Oral Implants Res 2016;27:282-7.
Oh SH, Kim Y, Park JY, Jung YJ, Kim SK, Park SY. Comparison of fixed implant-supported prostheses, removable implant-supported prostheses, and complete dentures: Patient satisfaction and oral health-related quality of life. Clin Oral Implants Res 2016;27:e31-7.
Schimmel M, Müller F, Suter V, Buser D. Implants for elderly patients. Periodontol 2000 2017;73:228-40.
Grogono AL, Lancaster DM, Finger IM. Dental implants: A survey of patients' attitudes. J Prosthet Dent 1989;62:573-6.
Strassburger C, Heydecke G, Kerschbaum T. Influence of prosthetic and implant therapy on satisfaction and quality of life: A systematic literature review. Part 1 – Characteristics of the studies. Int J Prosthodont 2004;17:83-93.
Pjetursson BE, Karoussis I, Bürgin W, Brägger U, Lang NP. Patients' satisfaction following implant therapy. A 10-year prospective cohort study. Clin Oral Implants Res 2005;16:185-93.
Topçu AO, Yamalik N, Güncü GN, Tözüm TF, El H, Uysal S, et al.
Implant-site related and patient-based factors with the potential to impact patients' satisfaction, quality of life measures and perceptions toward dental implant treatment. Implant Dent 2017;26:581-91.
Anderson JD. The need for criteria on reporting treatment outcomes. J Prosthet Dent 1998;79:49-55.
Zitzmann NU, Marinello CP. Treatment outcomes of fixed or removable implant-supported prostheses in the edentulous maxilla. Part I: Patients' assessments. J Prosthet Dent 2000;83:424-33.
Zimmer CM, Zimmer WM, Williams J, Liesener J. Public awareness and acceptance of dental implants. Int J Oral Maxillofac Implants 1992;7:228-32.
Berge TI. Public awareness, information sources and evaluation of oral implant treatment in Norway. Clin Oral Implants Res 2000;11:401-8.
Walton JN, MacEntee MI. Choosing or refusing oral implants: A prospective study of edentulous volunteers for a clinical trial. Int J Prosthodont 2005;18:483-8.
Rustemeyer J, Bremerich A. Patients' knowledge and expectations regarding dental implants: Assessment by questionnaire. Int J Oral Maxillofac Surg 2007;36:814-7.
Chowdhary R, Mankani N, Chandraker NK. Awareness of dental implants as a treatment choice in urban Indian populations. Int J Oral Maxillofac Implants 2010;25:305-8.
Satpathy A, Porwal A, Bhattacharya A, Sahu PK. Patient awareness, acceptance and perceived cost of dental Implants as a treatment modality for replacement of missing teeth: A survey in Bhubaneswar and Cuttack. Int J Public Health Dent 2011;2:1-7.
Pommer B, Zechner W, Watzak G, Ulm C, Watzek G, Tepper G. Progress and trends in patients' mindset on dental implants. I: Level of information, sources of information and need for patient information. Clin Oral Implants Res 2011;22:223-9.
Akagawa Y, Rachi Y, Matsumoto T, Tsuru H. Attitudes of removable denture patients toward dental implants. J Prosthet Dent 1988;60:362-4.
Tepper G, Haas R, Mailath G, Teller C, Bernhart T, Monov G, et al.
Representative marketing-oriented study on implants in the Austrian population. II. Implant acceptance, patient-perceived cost and patient satisfaction. Clin Oral Implants Res 2003;14:634-42.
Gharpure AS, Bhange PD, Gharpure AS. Awareness of dental implant treatment in an Indian metropolitan population. J Dent Implants 2016;6:62.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2]